All posts by CPTFeditor

Prophylactic or optional mastectomies

Breast Cancer, Breast Cancer, news-you-can-use
Diana Zuckerman, PhD, and Brandel France de Bravo, MPH

Every year, thousands of women choose to undergo a mastectomy (surgery to remove the breast tissue) when lumpectomy (removal of only a small part of the breast) would be an equally effective option for them. Some women choose a bilateral mastectomy (removal of both breasts, also called a double mastectomy) when there is cancer in only one breast. Even women who do not have breast cancer may undergo mastectomies as a preventive measure because of their high risk of breast cancer, as was the situation with Angelina Jolie. If either one or two breasts without cancer are removed, the surgery is called a “prophylactic mastectomy.”

Helping patients make an informed decision about whether to have a mastectomy is an important aspect of the physician-patient relationship. Unfortunately, many patients are not able to get the information they need from their physicians. A patient who is seriously considering a mastectomy or bilateral mastectomy that is not medically necessary may be basing her decision more on fear than on information. They may benefit from unbiased information, counseling, or from a second opinion before making a final decision.

The purpose of this article is to provide information that patients and family members can use to help them discuss their options with their physicians.

Should I remove one breast or both?

 Women in the U.S. who are diagnosed with early-stage breast cancer sometimes remove both breasts even if only one has cancer.  However, new research indicates that having a healthy breast removed in addition to the breast with cancer increases the chances of medical complications.  Even though removing a healthy breast lowers the risk of getting cancer in that breast in the future, the risk of cancer in that healthy breast was already less than 1% per year unless the woman has a BRCA gene or some other very high risk factor.1 Hormone pills such as tamoxifen or aromatase inhibitors can further reduce that already low risk. In a study of more than 4,000 women, removing the healthy breast (“contralateral breast”) doubled the chances of having wound complications in the first month after surgery: from about 3% for women who had only the breast with cancer removed to about 6% for women who also had the healthy breast removed. About 4% of women who had a single mastectomy experienced some kind of complication (not necessarily wound-related) in the 30 days after surgery, compared to 8% of women who had both breasts removed. Dr. Fahima Osman of the University of Toronto presented these findings at the 2013 meeting of the American Society of Breast Surgeons.2

What if I have a breast cancer gene (BRCA1 and BRCA2)?

Women with known mutations in the BRCA1 and BRCA2 genes have a lifetime risk of breast cancer ranging from 40% to 65% on average, compared to 12% for women in the general population. Women with BRCA1 or BRCA2 mutations often develop breast cancer before age 50 and have a high risk of bilateral breast cancer and ovarian cancer.3 Removing breasts with no sign of cancer is called a prophylactic (preventive) mastectomy. Prophylactic mastectomy and prophylactic oophorectomy (removal of the ovaries) have both been shown to greatly reduce – but not eliminate – the risk of breast cancer in BRCA mutation carriers.3  Among women with strong family histories of breast cancer, individuals of Ashkenazi Jewish descent have an 8 times greater frequency of carrying these mutations in BRCA1 or BRCA2 compared with other women.4

Lumpectomy with radiation therapy is just as effective for preventing same-breast tumor recurrence in breast cancer patients with BRCA mutations as it is for other women. Questions remain, however, about how other adjuvant treatments (such as chemotherapy) affect survival of women with these gene mutations.4

For women with the BRCA1 or BRCA2 genes, it is important to remember that the risk of breast cancer in the next 5 or 10 years is much lower than the lifetime risk of breast cancer. For example, the risk of breast cancer in her 20s is very low, even with BRCA1 (less than 3%) or BRCA2 (approximately 1%). For a 30-year old woman, the risk by age 39 is higher (10% for women with BRCA1 and 8% for BRCA2). For a 40-year-old woman, the risk by age 49 is 16% for women with BRCA1 and 13% for women with BRCA2.4 Although these 10-year risk levels are much higher than for most women, they are much lower than the life-time risk that is so frightening. It is also important to remember that cancer treatments and prevention strategies are improving, so the risks of cancer may decrease and the survival rates are improving.

Is there something I can do other than Prophylactic Mastectomies?

Prophylactic mastectomies can prevent breast cancer, but many women who undergo prophylactic mastectomies would never have developed breast cancer, even without the surgery.  To make an informed decision about whether to undergo a prophylactic mastectomy, women need a clear understanding of the risks and benefits as well as other strategies that also reduce risk.

Tamoxifen and raloxifene have both been shown to reduce the risk of breast cancer for women who have not had cancer but are at greater risk. These drugs can also reduce the risk of breast cancer for women with BRCA1 or BRCA2 mutations.

For women at high risk of breast cancer for any reason, routine screening starting at a young age can be an alternative to prophylactic mastectomy. Options include clinical breast exams, mammograms, ultrasounds, and MRIs. MRIs are much more accurate than mammograms for young women and women with dense breast tissue, and avoid the additional risks associated with radiation — risks that should be avoided by women who already are susceptible to breast cancer. A 2012 study of women with BRCA1/2 mutations who were under 30 years old showed that the increased radiation they were exposed to from early, frequent mammograms increased their risk of breast cancer. Women with the most radiation exposure had the highest risk of breast cancer, compared to other women with the same gene mutations.5 Those risks can be avoided by replacing early mammograms with MRIs instead. However, it is important to note that MRIs used for screening tend to result in overtreatment, including unnecessary biopsies and mastectomies.6

Research indicates that a low-fat diet, weight control, and exercise may reduce the risk of breast cancer for all women, including women at high risk and women who previously were treated for breast cancer.78

Screening for lung cancer: do risks outweigh benefits?

Lung Cancer
By Diana Zuckerman, PhD
2015

Lung cancer has a poor prognosis, with a survival rate of 20% at 5 years, but early-stage lung cancer has a better survival rate and is more responsive to treatment. Medicare and U.S. insurance companies now pay for lung cancer screening with low-dose CT (LDCT) scans for former smokers to help diagnose lung cancer at its earliest stages. Still, screening has not been shown to reduce most lung cancer deaths.

Three major studies were used to inform the latest lung cancer screening guidelines proposed by the US Preventative Services Task Force: The National Lung Cancer Screening Trial (NLST), Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON) trial, and Cancer Intervention and Surveillance Modeling Network (CISNET). It is important to note, these studies differed in eligibility criteria (age and smoking history), number of screening rounds (2-5), screening intervals (annual, biannual, escalating), and definitions of a positive screen (4mm, 5mm, volume-based) making it difficult to uniformly apply results to the clinical setting.

Still, these studies found fewer deaths in patients 50-80 years of age who had smoked for at least 20 pack-years (1 pack of cigarettes per day for 20 years, or 2 packs a day for 10 years, etc.) within the past 15 years and were screened with LDCT scans rather than chest x-ray. Patients were 20% less likely to have died within 6.5 years of screening and 25% less likely to have died within 10 years. Lung cancer was also more frequently diagnosed at an early-stage rather than at a late-stage, yielding the best chance for treatment success and survival.

However, the populations in these studies were not reflective of a diverse patient population and the majority were white, male, affluent, and did not have any other major diseases. This means that there is a major potential for discrepancies in screening effectiveness across a more diverse patient population and a sicker population, which is more reflective of the clinical setting. Screening can also lead to serious harms including false-positive results (a result showing that you have lung cancer when you do not), incidental findings that lead to invasive testing, and increased radiation exposure.

Overall, major questions regarding lung cancer screening still remain:

  • What evidence is there that Medicare patients with a 20-pack-year smoking history benefit from LDCT screening?
  • Are these patients healthy enough to benefit from surgery?
  • What are the harms of lung cancer screening and finding incidental health abnormalities?

The US Preventive Services Task Force has recommended LDCT screening for people ages 50-80 with a 20 pack-year history of smoking within the last 15 years. However, those experts warn that “screening does not prevent most lung cancer deaths.” In fact, even if patients who are screened with LDCT scans are diagnosed earlier and live longer with the diagnosis, they may die at the same age they would have without screening. In other words, a patient diagnosed after screening at age 65 might live to be 68 whereas, if they were not screened, they might have been diagnosed at 67 but still have died at the age of 68. Age is also an important risk factor for lung cancer, and screening Medicare patients may decrease the number of lung cancer deaths by intervening on the highest-risk population. However, surgical recovery is more taxing and there are fewer quality years to be gained within this population.

The answer to the second question is difficult to know. The patients studied in the major clinical trials used by the US Preventative Services Task Force to make their recommendation on lung cancer screening did not have any other major diseases apart from lung cancer. It is also recommended that screening be discontinued if a patient develops a significant health problem. In one particular study, the NLST, half were as likely to have emphysema, diabetes, or heart disease as most smokers the same age. Typical Medicare patients eligible for LDCT screening generally have more health problems. It is less likely that Medicare patients would be healthy enough to undergo medical or surgical cancer treatment and fewer than 7% would likely benefit by living longer.

Another major concern is that lung cancer screening has health risks. A range of false-positive (a result showing that you have lung cancer when you do not) rates have been reported from 10-29% at initial screening. Aside from the unnecessary anxiety a false-positive result can cause, it can also lead to unnecessary radiation exposure from repeat CT scans, unnecessary procedures such as biopsies, and in extreme cases unnecessary surgery occurring in 0.5-2% of the study population who underwent LDCT screening. Lung cancer screening can also detect more than just lung cancer and other significant abnormalities may be found, termed incidental findings. Incidental findings have been reported at a rate of 10-34% with 89% of incidental findings requiring further clinical evaluation. While this may present an opportunity for early intervention on an important condition that otherwise would not have been found. Incidental findings may also cause unnecessary financial and emotional burdens, result in harmful complications, or lead to inappropriate medical care.

The benefits and risks of lung cancer screening with LDCT scans will likely continue to evolve. Currently, there are major gaps in lung cancer screening research that need to be addressed in order to fully understand the impact of the US Preventative Services Task Force recommendations: (1) the impact of lung cancer screening on mortality across age, health status, and smoking history, (2) effectiveness in a more diverse patient population, and (3) the long-term, cumulative harms of low-dose radiation exposure.

 

Last updated July, 2023

Bill aims to expand drug indications minus randomized trials

In the News
By Robert Lowes,  Medscape
May 08, 2015

Can government regulators speed up the introduction of new treatments in hospitals and physician offices without sacrificing safety and effectiveness? Or does the expression “speed kills” hold true?

That’s the debate surrounding a bill in the Republican-controlled House called 21st Century Cures, which aims to fast-track the development and approval of new drugs and devices. Ironically, the legislative process has been slow-going as lawmakers strike compromises to defuse controversy.

The latest draft of the bill, released last week, won kudos from Democrats and Republicans alike for significantly increasing the budget of the National Institutes of Health (NIH), which funds basic research leading to new treatments. However, some experts still worry that the measure, not yet officially introduced as legislation, lowers the scientific bar for these new treatments to come to market — good for manufacturers, but not so good for patients.

One provision, for example, requires the US Food and Drug Administration (FDA) to evaluate the use of evidence from “clinical experience” — and not just from randomized clinical trials — for assessing a drug’s effectiveness and safety in two regulatory scenarios. One is to “help support the approval” of a new indication for a drug already on the market. The other is helping to support or satisfy postapproval studies that the FDA requires when it has its doubts about a drug.

Evidence from clinical experience, as described by the bill, includes data from observational trials, clinical registries, insurance claims, ongoing safety surveillance, and “patient-centered outcomes research activities.”

Diana Zuckerman, PhD, president of the nonprofit National Center for Health Research (NCHR), a think-tank that focuses on women, children, and families, looks askance at substituting clinical experience for randomized clinical trials. She told Medscape Medical News that the bill “would promote the snake oils and elixirs of the early 20th century.”

“I call it eminence-based medicine — if some hotshot doctor says it works,” Dr Zuckerman said.

The push to consider clinical experience for expanding a drug’s indications, she said, is based on the false assumption that once the FDA deems a drug safe for an initial indication, “it can be used for everything else.” That assumption forgets that the FDA weighs benefits versus risks. The agency, for example, might approve a very toxic drug for a certain lung cancer because nothing else would save a patient’s life. However, the FDA may find the drug’s toxicity unacceptable when it comes to treating early-stage breast cancer, a condition for which there are many alternative treatments, and a far higher survival rate.

“Safety is very, very relative,” said Dr Zuckerman.

21st Century Cures also has come in for harsh criticism from the consumer watchdog group Public Citizen, which said that faster product approval based on weaker evidence will sacrifice safety, and Modern Healthcare magazine, which called the measure the “21st Century Quackery Act.” Yet another critic is Margaret Hamburg, MD, who stepped down as FDA commissioner earlier this year. Addressing the National Press Club in March, Dr Hamburg warned against relaxing the agency’s standards. “Innovation doesn’t matter if the product doesn’t work,” said Dr Hamburg, an appointee of President Barack Obama.

However, Politico Pro quotes another former FDA commissioner as saying that, unlike Dr Hamburg, he views the measure as a “positive step.”

“I don’t share the concern that inherently this means you are going to have to lower standards of safety and efficacy,” said Andrew von Eschenbach, MD, Wednesday, at a media briefing on 21st Century Cures organized by the Alliance for Health Reform. Dr von Eschenbach headed the FDA from 2006 to 2009 under President George W. Bush.

“The FDA’s Not Going to Do Anything That’s Inappropriate”

In an interview with Medscape Medical News, a high-ranking FDA official said that the agency already has begun to approve drugs based on clinical evidence short of randomized trials, and that it is proceeding cautiously.

“The FDA’s not going to do anything that’s inappropriate,” said Janet Woodcock, MD, director of FDA’s Center for Drug Evaluation and Research (CDER).

The FDA has sometimes relied on single-arm trials and case series to establish efficacy for new drug approvals or expanded indications, said Dr Woodcock. This approach holds promise, she said, for approving new uses of targeted cancer drugs already on the market, especially for rare tumor types in patients who don’t have other good treatment options.

At the same time, the FDA recognizes the limits of clinical evidence, including “pure observational data” gleaned from its own nascent Sentinel System, which searches the electronic health records of some 178 million patients for adverse events.

“It isn’t reliable enough [yet],” said Dr Woodcock. “We don’t even make definitive safety findings from that. We use it to bolster our safety assessments.”

So the FDA is still learning how to harness such clinical evidence. The future, she said, will “bring clinical research much closer together with healthcare.”

Less Industry Friendly?

21st Century Cures has been in the making since May 2014, when the initiative was unveiled by Rep. Fred Upton (R-MI), chair of the House Energy and Commerce Committee, and committee member Rep. Diana DeGette (D-CO).

In January 2015, the committee released a first draft of the legislation, which was criticized as catering to industry. Some of the most controversial provisions would have extended market exclusivity for various categories of drugs. The NCHR’s Dr Zuckerman credits lawmakers with removing this language from the latest draft.

Also missing, said Dr Zuckerman, are “micromanaging” provisions on biomarkers, those organic fingerprints such as RNA, proteins, and metabolites that can predict a patient’s response to a drug — one of the keys to personalized medicine. Under the first draft, she said, drug makers could have essentially pressured the FDA to adopt biomarkers of their choosing to expedite clinical trials. The draft legislation released last week merely calls on the agency to develop guidelines for developing biomarkers, a gentler directive for an agency already incorporating these measures into its work.

CDER’s Dr Woodcock told the health subcommittee of the House Energy and Commerce Committee on April 30 that biomarkers must pass the evidence test before the FDA accepts them as proxies for health outcomes.

“You have to know those biomarkers are reliable before you risk them on human life,” said Dr Woodcock.

Bill Exempts Some CME Activities From Sunshine Reporting
The latest version of 21st Century Cures covers a waterfront of issues. Among other things, the measure would:

Require the FDA to establish a priority review program for “breakthrough” medical devices “for which no approved alternatives exist.”

Establish that the FDA can consider registry data, peer-reviewed studies, and data collected outside the United States in evaluating medical devices. Like the proposed acceptance of clinical evidence other than randomized clinical trials, this provision has been criticized as a license for weaker scientific evidence.

  • Require the Centers for Disease Control and Prevention to set up a surveillance system for neurological diseases.
  • Require the FDA to incorporate patient-experience data in its regulatory decisions, a path the FDA is already headed down. “Patients are experts in their disease,” Dr Woodcock told lawmakers last week.
  • Allow NIH to require any researchers it supports to share their data.
  • Create an information system for scientists to use and analyze data from NIH-funded trials.
  • Create a fast-track approval process in the FDA for antibiotics in short supply.
  • Encourage the application of Bayesian statistical modeling in drug makers’ clinical protocols and new drug applications.
  • Exempts some continuing medical education activities of physicians from the controversial Sunshine Act. Drug and device manufacturers wouldn’t have to report giving physicians a medical textbook, tuition to attend an educational event, or a fee to speak at such an event.
  • Allow drug makers to share economic data concerning their products with third-party payers and their formulary committees.

The measure seeks to make electronic health record systems interoperable so that physicians can easily share research and clinical data, but lawmakers have not yet come up with specifics. Details also are pending for a provision seeking to make telemedicine more available to physicians and patients, and to repurpose drugs for serious and life-threatening diseases.

The general thrust of all these measures is to accelerate the development, testing, and market debut of new medical treatments. Bill supporters view the FDA approval process as antiquated and too slow, but Dr Woodcock noted in her House subcommittee testimony last week that her agency has been quicker on its feet lately. Last year, she said, the FDA okayed the highest number of new drugs in almost 2 decades, and the most new drugs for “orphan” diseases since Congress passed the Orphan Drug Act in 1983.

She also suggested that the FDA’s depiction as a bottleneck for innovation is exaggerated. The agency, she said, consistently reviews new drugs faster than its counterparts around the world.

“We don’t take a long time to get things approved,” said Dr Woodcock. “They take a long time to get developed.”

Bigger Budget for NIH, but Not for FDA

Appropriations for NIH shrank for 3 consecutive years beginning in 2011, reflecting across-the-board federal budget cuts that grew out of Congressional gridlock. The latest version of 21st Century Cures would significantly boost NIH funding, making the measure more palatable to Congressional Democrats and delighting the healthcare industry.

“The increased funding for the NIH in the 21st Century Cures draft is an important acknowledgement of the need for robust research,” said Kim Williams, Sr, MD, president of the American College of Cardiology, in a news release.

The draft legislation would lift NIH’s budget line to $31.8 billion in fiscal 2016, up from $30.3 billion in 2015. Increases of $1.5 billion would follow in both 2017 and 2018. The measure would allocate an additional $2 billion a year over 5 years for an NIH Innovation Fund to support, among other things, emerging young scientists and research in precision medicine.

At last week’s hearing of the health subcommittee of the House Energy and Commerce Committees, several lawmakers noted that the measure did not give the FDA more money even though it gave the agency more work to do.

Dr Woodcock acknowledged that the FDA is already “very stretched” and that giving its staff additional responsibilities could slow down its drug review program, which “is going full speed.”

“We have a saying in medicine — first, do no harm,” she said. “In enacting new legislation, you don’t break what’s fixed.”

Jeffrey Shuren, MD, director of the FDA’s Center for Devices and Radiological Health, added that more duties for the same number of FDA employees worsens turnover, as does noncompetitive salaries. “Were essentially a training ground for industry,” said Dr Shuren.

The 21st Century Cures draft needs additional tinkering to address this money problem, Rep. DeGette told Dr Shuren and Dr Woodcock.

“We still need to find the funds for the FDA to do the things you have to do,” DeGette said.

See original article here. 

Bill to speed approvals for drugs is cut back

In the News, News Stories & Editorials
By Sabrina Tavernise,  New York Times
April 30, 2015

WASHINGTON — Legislation that would have accelerated the pace of federal drug approvals in a way that critics said threatened to erode patient safety was formally released this week, in a scaled-back version with many of the most controversial provisions left out.

The  draft bill  presented at a  hearing  in the House on Thursday represents a less aggressive streamlining of the drug approval process, critics of the earlier draft said, and seems to have secured strong bipartisan support.

The legislation, called 21st Century Cures, has been in the works for months. Its lead sponsor, Fred Upton, Republican of Michigan, said it would speed the pace of drug cures by removing unnecessary hurdles from the regulatory process.

Critics, including top officials at the  Food and Drug Administration,    had expressed concern that the changes would risk patient safety — for example, by potentially permitting shorter clinical trials and letting drug companies use alternative measures of health as evidence of a drug’s effectiveness and safety.

The bill’s supporters said it was a work in progress that had been assembled in one of the most collaborative, transparent processes Congress has seen in years. The sponsors held eight hearings and more than a dozen round-table meetings in districts across the country to gather comment.

“We have a chance to do something big, and this is our time,” Mr. Upton said.

His co-sponsor, Diana DeGette, Democrat of Colorado, said the lawmakers had made “tremendous progress,” recalling “that hokey video” that she and Mr. Upton made to promote the effort last year.

The draft — at about 200 pages it is half its former size — seemed to allay fears among some experts that it would fundamentally rewire the way drugs are approved. Earlier proposals to give drug companies broad powers to promote their products for uses other than the approved ones and to market brand-name drugs for a longer time without generic competition were not included.

The F.D.A. has defended its record for drug approval speed, saying that in 2014, it approved the most new drugs in almost 20 years, and that it moves faster than its counterparts in other wealthy countries. Experts note that pathways exist for expedited approval, and that the F.D.A. is held to relatively strict timelines under other rules set by Congress. Instead, they say, the bottleneck for new drugs is often a matter of the years of research it takes to find them.

Diana Zuckerman, the president of the National Center for Health Research, said earlier versions of the legislation had “considerable micromanaging of the F.D.A. and enormous power given to industry.”

She added, “Most of that is gone.”

But she cautioned that the bill still held numerous provisions she believed put people at risk, including ones she described as lowering standards for the approval of medical devices and antibiotics. The bill would increase the work the F.D.A. must perform, but not the money it receives, and Dr. Janet Woodcock, an agency official who testified Thursday, said that was a concern.

“We are very stretched in our resources,” she said.

One point that is likely to concern the F.D.A. is a provision that would reduce its authority to regulate some software associated with medical devices.

An earlier version of the bill would have let drugmakers use quicker measures for a drug’s effectiveness during testing — for example, changes in blood sugar level instead of a more final outcome, like development of  diabetes. The new draft instead suggests ways the F.D.A. could use those alternative measures, called biomarkers.

The F.D.A. says it already uses them in a substantial share of drug approvals, and Dr. Woodcock told the lawmakers Thursday that the agency did not need additional authority on this count. Progress has been slow in adopting more biomarkers, she said, because they often did not produce enough evidence to allow scientists to draw firm conclusions.

“You have to know those biomarkers are reliable before you can take a chance on a human life,” she said.

See the original article here.

Good news for coffee drinkers: the health benefits outweigh the risks for most people

Colon Cancer, Diet, Habits, & Other Behaviors, Other Cancers, Skin Cancer, Skin Cancer
By Morgan Wharton, Jessica Cote, and Shahmir Ali ABD

latte-249102_640Most Americans drink coffee every day.9 The caffeine in coffee helps us stay alert but also may cause jitteriness and interfere with sleeping. A few studies suggest that decaffeinated coffee also has health benefits, perhaps because of antioxidants or acids in the coffee bean.10

What Are The Health Benefits Of Drinking Coffee?

For years medical experts advised people to drink less coffee, mostly because of research suggesting coffee might increase the risk of heart disease. However, numerous studies conducted recently have discovered coffee’s unexpected health benefits. Like all well-designed research, most of these studies considered the impact of age, sex, body mass index (BMI), physical activity, tobacco use, and whether family members had developed cancer. By controlling for those factors, researchers made sure they could separate coffee’s impact on health from the effects of people’s lifestyle, family history, and previous health problems. However, the type of coffee you drink may influence its health benefits; a very large study from the UK published in 2022 found that adults who drank larger quantities of unsweetened or sugar-sweetened coffee were less likely to die from cancer in the subsequent 7 years, and also less likely to die from any cause during that time frame.11  However, drinking more artificially sweetened coffee had no impact on cancer or other deaths.

Colorectal Cancer

Meta-analyses are a kind of statistics that combine data from several comparable studies to make one very large study. These results are usually more accurate than any one study can be. Taken together, three meta-analyses suggest that drinking about four or more cups of coffee per day may reduce the chances of getting colorectal cancer by 11-24%.121314

Endometrial (uterine) Cancer

Using data from 67,470 women who participated in the Nurses’ Health Study, researchers found that women who drank four or more cups of coffee per day were 25% less likely to develop endometrial cancer than women who drank only one cup of coffee per day. Compared to women who did not drink any coffee, those who drank four cups or more per day were 30% less likely to develop endometrial cancer. Decaffeinated coffee was just as effective as caffeinated coffee, but caffeinated tea did not lower the risk of endometrial cancer.15

Liver Cancer And Cirrhosis (Scarring of the Liver/Chronic Liver Disease)

One study found people who drank one or two cups of coffee per day had a slightly lower risk of getting the most common type of liver cancer compared to non-drinkers, but people who drank three or four cups of coffee were about half as likely as non-drinkers to get this kind of liver cancer. Meanwhile, people who drank five or more cups per day had an even lower risk than that (about one-third the risk of non-drinkers).16

Similarly, a study in Japan found a 76% decrease in the risk of that type of liver cancer in people who drank at least five cups of coffee per day compared to those who did not drink coffee. The strongest benefit was seen in individuals with hepatitis C, a disease which increases a person’s risk of developing liver cancer, although the researchers were not sure why.17

A study of 120,000 Americans over an 8-year period found a 22% decrease in the chances of developing cirrhosis for each daily cup of coffee. In Norway, a 17-year study of 51,000 citizens found that those who drank two or more cups of coffee per day were 40% less likely to develop cirrhosis compared to those who did not consume coffee.18

Skin Cancer

Using data from two enormous studies, the Nurses’ Health Study and the Health Professionals Follow-up Study, researchers found that men and women who drank more than three cups of caffeinated coffee per month were 17% less likely to develop basal cell carcinoma compared to people who drank less than one cup per month. Basal cell carcinoma is the most common and least dangerous type of skin cancer. Drinking decaffeinated coffee did not affect basal cell carcinoma.19

A 2014 study in the Journal of the National Cancer Institute found that the more coffee participants drank, the less likely they were to develop malignant melanoma over a 10 year period. Melanoma is the most dangerous form of skin cancer. Almost 450,000 whites, aged 50-71, participated in the study. Researchers found that drinking four or more cups of coffee per day was linked to a 20% lower risk of getting malignant melanoma. Once again, drinkers of decaffeinated coffee lost out. Their risk of getting melanoma was no different from that of non-coffee drinkers. Coffee drinking, however, did not affect the least dangerous form of melanoma, called melanoma in situ.

Remember that no matter how much coffee with caffeine you drink, the best way to prevent skin cancer is still to limit your time exposed to the sun and ultraviolet light! 20

Type 2 Diabetes

People in Finland consume more coffee than almost any other nation, and a study of 14,000 people over 12 years  found that men who drank 10 or more cups of coffee daily had a 55% lower risk of developing type 2 diabetes than men who drank 2 cups of coffee a day or fewer.  Even more dramatic, women who drank 10 or more cups per day had a 79% lower risk of developing type 2 diabetes than those who drank fewer than 2 cups daily.21

A different Finnish study of 5,000 sets of identical twins found that individuals who drank more than seven cups of coffee per day had a 35% lower risk of type 2 diabetes than their twins who drank two cups or fewer per day.22 Because identical twins are so biologically similar, the difference in disease risk is very likely caused by coffee consumption levels. Studies of fewer people in other countries have found less dramatic but similarly positive results.

Parkinson’s Disease

A study of more than 8,000 Japanese-American men found that men who did not drink coffee at all were three to five times more likely to develop Parkinson’s disease within 30 years than men who drank four and a half cups or more of coffee per day.23

Suicide

Because suicide may be related to alcohol intake, medications, and stress levels, suicide studies took those factors into account.  A 10-year study of 128,000 people in California found that the risk of suicide decreased by 13% for every additional cup of coffee consumed per day. Even one cup of coffee per day seemed to reduce the risk of suicide. A different 10-year study of 86,000 women found a 50% lower risk of suicide for those who drank two or more cups of coffee per day compared to women who did not drink coffee.24

Brain Power and Aging

A study of 676 healthy men born between 1900 and 1920 suggested that coffee helped with information processing and slowed the cognitive decline typical of aging. Cognitive functioning was measured by the Mini-Mental State Examination, a 30 point scale. Men who regularly consumed coffee experienced an average decline of 1.2 points over 10 years, while men who did not drink coffee saw a decline of 2.6 points over 10 years. Men who drank three cups of coffee per day declined only 0.6 points over 10 years.25

Even old mice are sharper with caffeine: a study using a mouse model of Alzheimer’s disease showed that coffee actually reversed the cognitive decline and slow-down in processing that occurred with age. Mice given caffeine in their water showed signs of recovering their memory during testing.26

What about the risks?

Childbearing

Two separate studies found that 300 mg of caffeine (two to three cups of coffee) decreased a woman’s chances of getting pregnant by more than a third. This same amount of coffee also increased the chances of women having low birth-weight babies by 50%. These studies took into account potentially influential  factors such as contraception used in the past and infertility history.27

Hip Fracture

According to data from the Nurses’ Health Study, women aged 65 and over who drank more than four cups of coffee per day had almost 3 times as many hip fractures over the next six years as women who did not drink coffee. Researchers took important factors into consideration such as how much calcium the women consumed each day.28

Parkinson’s Disease among post-menopausal women taking estrogen-only hormone therapy

Other researchers used data from the Nurses’ Health Study to evaluate the risk of Parkinson’s disease among women who drank coffee while using estrogen medication after menopause. For women who were NOT using estrogen therapy, those who drank four or more cups of coffee per day were about half as likely to develop Parkinson’s disease as women who did not drink coffee. For women who did use post-menopausal estrogen, however, those who drank four or more cups of coffee were about twice as likely as those who didn’t drink coffee to develop Parkinson’s.29

Heart Disease

Two different meta-analyses found that people who drank five or more cups of coffee per day were 40-60% more likely to develop heart disease compared to those who did not drink coffee at all. Other studies have also shown that high coffee use (five to ten cups per day) increases the risk of heart disease, while moderate consumption (three to four cups daily) was not associated with a higher risk. Only coffee drinkers who consumed more than nine cups a day had a greater risk of dying from heart disease.30 It is important to consider that people drinking close to 10 cups of coffee a day are likely to have other health problems, such as stress or sleep deprivation, and this could contribute to higher risk of heart disease and death regardless of coffee use.

Bottom line

For most people, drinking coffee seems to improve health more than harm it. Many of coffee’s health benefits increase with the number of cups per day, but even one cup a day lowers the risk of several diseases. However, women who want to get pregnant or already are pregnant and women over 65 should probably limit their coffee intake because, in their case, the risks may outweigh the health benefits.

Even though many studies show coffee has benefits, it’s still not clear why. How can one popular beverage help metabolism (for example, lowering the risk of type 2 diabetes) and also protect against a range of cancers? Until further research can solve that puzzle, most adults should continue to enjoy their cup (or two, or three) of Joe. Finally, remember that nearly all studies on coffee and health have been done on adults. Coffee may affect children and teens differently.

A Beautiful Day for our First Annual Lap-a-Thon in Leesburg, VA on April 26!

Events

Our first Stop Cancer Now Lap-a-Thon at Tuscarora H.S. on Sunday April 26th was a great success!

IMG_1708Lapthon action shot Lapthon closeup with Ben Lapathon 4 girls including Abbyphoto (12)

 

 

More than $5,000 was raised to support our Cancer Helpline by adults and children who participated on one of 4 teams or as individuals.

 

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Track Team

Lap-a-Thon Baseball Team Pic

Baseball Team
Baseball Team

Winners included:

Most money raised by a team:

Baseball: $1592

Track: $1285

Team Bob: $1150

Most people registered by a team:

Track: 50

Baseball: 44

Team Bob: 24

Most laps by a team (approximate, due to technical difficulties!):

Track team: 404

Baseball team: 381

Top female lapper

Anna Wasko: 17 laps

Top male lapper

Greg Fenner: 20  laps

Best outfit representing the Colors of Cancer Awareness

Tammy Skov

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Congratulations to our Cancer Color Awareness costume contest winner!

 

At the conclusion of the Lap-a-Thon, we read the names of all the friends and loved ones who we ran or walked in honor of or in memory of, and released the balloons skyward!IMG_1740IMG_1753

Special thanks to Michele Knuff (THS parent of Abby and Ben) for making this great Lap-a-Thon a reality!

image9
Abby, Ben, and Michele Knuff

 

We are very grateful to Savannah’s of Leesburg, our wonderful Gold Level sponsor and to the Hershey’s Shake Shop, Potomac River Running Store, ResQ BBQ Catering, Manhattan Pizza, Reston Shirt and Graphic Company, and  Mullen Orthodontics, our terrific Bronze Level sponsors!

——————————– April 26, 2015 Lap-A-Thon Teams ——————————–

TEAM Bob

Bob Knuff at the beach, 2012
Team Knuff at the Cancer Prevention and Treatment 5k in 2013 http://dev.stopcancerfund.org/events/
Team Knuff at the Cancer Prevention and Treatment 5k in 2013

 

 

 

 

 

 

 

 

 

 

Team Bob will participate in loving memory of Bob Knuff, amazing husband, dad, brother, uncle, friend, co-worker, coach and neighbor. . . Supporting Carcinoid Cancer Research and Awareness one day at a time. GET YOUR ZEBRA ON!!!

“Another turning point, a fork stuck in the road. Time grabs you by the wrist, directs you where to go. So make the best of this test, and don’t ask why. It’s not a question, but a lesson learned in time. It’s something unpredictable, but in the end is right. I hope you had the time of your life. 

So take the photographs, and still frames in your mind. Hang it on a shelf of good health and good time. Tattoos of memories and dead skin on trial. For what it’s worth, it was worth all the while. I hope you had the time of your life.”

Registered to participate on This Team:

Janet Czyrnik                       $25

Michele Knuff                       $25

James Stankard                  $100

Hannah Ambrose                $25

Lance Ambrose                  $25

Mariann Ambrose                $25

Olivia Ambrose                    $25

John Ambrose                    $25

Janice Weber                     $25

Carol Taylor                        $25

Landon Taylor                    $25

Darren Hemminger            $25

Marcy Hemminger             $25

Keely Hemminger              $25

Carrie Czyrnik                    $25

Jane Taylor                        $200

Noah Klemm                      $25

Maddie Evans                    $25

Brian Love                           $25

Jamie Savoie                      $25

Terri Azie                            $20

Erin Azie                             $25

Lauryn Azie                        $25

Mark Weber                        $25

Donors:

David Massey                    $100

Megan Last                        $10

Christy Hoke                      $50

Anonymous                         $50

Janice Weber                      $75

Jack Corso                          $25

Thomas Payne                    $25

Leslie Payne                       $25

 

Tuscarora High School’s Coed Varsity Track and Field Team’s TEAM

The Tuscarora High School’s Coed Varsity Track and Field team proudly creates a Lap-a-Thon TEAM to Stop Cancer Now!

“A job worth doing is worth doing together”

Registered to participate on This Team:

Abby Knuff                  $25

Troy Harry                   $25

Sarah Howorth            $45

Deena Sbitany             $25

Kmaljeet Athwal           $25

Anna Wasko                $25

Judy Wasko                 $25

Jason Holder                $20

Jennifer Holder             $20

Fred Holder                   $20

Gillian King                   $25

Wendy King                 $25

Rachel Grizzle             $25

Allyson Shepherd        $50

Tracey Lam                  $25

Mason Ong                  $50

Helen Horne               $25

Molly Carroll                 $25

John Irvine                   $25

Mariam Kolbai              $25

Skylar Ambuhl             $25

Leyla Kolbai                 $25

Dawson Lazorchak      $25

M.E. Lazorchak            $25

Jamie Fuhrmann          $25

Pamela Michel             $25

Imelda Ogango           $25

Maya Ogango             $25

Darby Watts                $25

Nehemiah Robinson   $10

Kobe Robinson           $10

Libby Forcade             $25

Sophie Aros                 $25

Caitlyn Davis               $25

Brittany Hill                  $25

Roman Patrick             $25

Mackenzie Anzueto      $25

Val Bourke                   $50

Emma Weary              $25

Lisa Clippinger             $25

Ty Reeves                    $25

Ivan Boyarskiy              $10

Donors:

Chiya Chambers          $10

Tuscarora High School’s Baseball Team’s TEAM

Huskies_Logo_with_Words_Black

The Tuscarora High School Baseball team is proud to announce our Lap-a-Thon TEAM to Stop Cancer Now!

“One Lap Warriors”

Registered to participate on This Team:

Ben Knuff                 $25

Wes Glass               $25

Lowell Skoc             $25

Tammy                     $25

Joey Skov                $25

David Drummond      $25

Donny Morris            $25

Terri Desimone         $25

Garrett Zendek        $25

Chad Musa              $50

Mary Lou Blue          $25

Christina Corbin       $25

Danine Stickles         $25

Greg Glass               $25

Susan Glass             $25

Kathy Giuliano          $25

Nicholas Giuliano      $25

Laura Giuliano          $25

Ki Giuliano                $25

Devin Welsh              $50

Dominick Marinelli    $25

Mike Marinelli           $25

Christine Kim            $25

Yehudit Shemtov      $102

Brad Kost                 $25

Debbie Wagner        $25

Carson Wagner        $25

Parker Bednoski       $50

Mark Bauer              $25

Marla Giuliano          $50

Joseph Giuliano        $50

Terry Morris               $25

Larry Morris               $25

Noah Lacy                 $20

Jonathan Lacy           $20

Joann Townsend       $25

Ann Capitano             $25

Audrey Messina          $50

Joy Messina                $50

Ryan Ahern                $25

Steve Kim                   $25

Zach Daughtry            $50

Madeleine Gabriele     $50

Donors:

Michael Hoehn         $200

 

TEAM Ann

IMG_0592 (1)
Ann Koch

Team Ann is in memory of Ann Koch, a very loving and fun Mother, Grandmother and friend. She passed away in October of 2014. She loved to garden, read on the beach, travel, and do just about anything outdoors, so our Lap-a-Thon Team will be thinking of her as we enjoy the outdoors on April 26th.

Registered to participate on This Team:

Judy Keiper            $25

Brandon Keiper      $25

Tom Koch             $100

Elizabeth Gilmore  $100

cancer hands long banner (2)

You don’t need to be on a team to participate! Thanks to our other Stop Cancer Now Lap-a-Thon participants and Donors as well!

 

Chris McCabe Thomas McNamara        $150

Miles Spence                                               $10

 

We are running...

In honor of:

In memory of:
David Mitchell Peter DeMann
Maria Aros Bob Knuff
Deborah Arciuolo MaryAnn Miller
Stasy Baltauskas Ted Miller
Theresa Peluso Clarence Knuff
Pat Kennedy Ann Koch
Suzanne Graft Mai Nguyen
Suzanne Ong Bill Grizzle
Kathy Giuliano David Albert
Kathy Hayes Gloria Bell
Nam Cho Jennie Lee Glass
Barbara Bunch Sally Briggs
John Begley Gavin Rupp
Debra Weary Jim Casper
Lillie Mae Reeves John Didier
Marcia Hemminger Andy Thomas
  Lynn McNamara
  Ram Sharma
  Iris June Wray
  Betty Harlow

Please be sure to thank our Generous Sponsors!

Gold Level Sponsor

Savannah-s-Logo-page-001

Bronze Level Sponsors

logo and blue tag

Hershey’s Shake Shop
700 Fieldstone Dr. #114
Leesburg, VA 20176

 

prlogo_9loc_blue

 

ResQ-BBQ-JPG

ResQ BBQ Catering, Leesburg, VA
resq-bbq.com
703-801-3775
Mullen Ortho Logo image1509 Dodona Terrace SE, Suite 201
Leesburg, VA 20175

 

 

reston t-shirt

341 Victory Drive
Herndon, VA 20170
703-318-4802

 

Manhattan Pizza logoMarketplace at Potomac Station
647 Potomac Station Dr
Leesburg, VA 20176
(703) 669-4020

What do stakeholders think of FDA’s latest effort to get patients timelier access to devices?

News Stories & Editorials, news-you-can-use
By Michael Williamson, Bloomberg BNA

The FDA April 8 released two final guidance documents that will help provide timely patient access to high-quality, safe and effective medical devices for unmet medical needs, Jeffrey Shuren, the director of the agency’s Center for Devices and Radiological Health, said in a blog posting.

Reaction to the two documents is mixed – pitting industry against some patient advocates.

One guidance document describes the FDA’s Expedited Access Program (EAP), which should “speed qualifying devices to patients with life-threatening or irreversibly debilitating conditions” without compromising the agency’s high standards for safety and effectiveness, Shuren’s blog posting said. The other guidance document outlines the agency’s current policy on balancing premarket and postmarket data collection during FDA review of premarket approval (PMA) applications. In addition, the document addresses whether or not the circumstances when postmarket data collection is appropriate for PMAs meet the criteria for the EAP.

Two stakeholders seemed pleased with the EAP document. The Advanced Medical Technology Association (AdvaMed), “commends the agency for its efforts to explore supplementary review pathways to provide more timely patient access to new technologies for life-threatening or irreversibly debilitating diseases or conditions that addresses an unmet medical need,” Janet Trunzo, the association’s senior executive vice president for technology and regulatory affairs, told me in a April 9 e-mail.

In addition, Ben Moscovitch, officer with the medical device project of the Pew Charitable Trusts, a nonproft policy organization, told me April 9 many of the recommendations his group made on the draft version of the EAP document were included in the final document. For example, he told me that the EAP final guidance document reflects a Pew suggestion from 2014 that the FDA should require the initiation of postmarket trials and completion of those studies within a certain timeframe.

Not everyone is pleased with the guidance, however. The EAP final guidance “is part of a larger problem where the FDA is bowing to pressure from Congress to weaken safeguards that are intended to protect patients from unsafe medical products,” Diana Zuckerman, president of the National Center for Health Research, told me in an April 9 e-mail. She is also president of the Cancer Prevention and Treatment Fund.

See the original article here.

Medicare panel voices doubts about genetic cancer tests

News Stories & Editorials, news-you-can-use
By Virgil Dickson, Modern Healthcare

The Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) has expressed little confidence in genetic tests that supposedly predict common cancers. The decision raises doubts about whether the CMS will authorize Medicare coverage for such tests.

“This is such a promising and exciting field, but the excitement is far ahead of the data,” said Diana Zuckerman, a panel member and president of the National Center for Health Research, an advocacy organization. These tests “could be so helpful if only we knew more.”

Specifically, there was a concern among committee members who met Tuesday about the lack of data regarding clinical utility, which indicates if a test result was actually helpful to a consumer.

“The evidence got very thin, very quickly,” said Dr. Beverly Guadagnolo, a panelist and associate professor in the radiation oncology department at the University of Texas.

Industry stakeholders present at the meeting disagreed. “Two hundred-plus labs around the country wouldn’t be doing these tests if they didn’t have clinical utility,” Dr. Jan Nowak, medical director of molecular diagnostics and cytogenetics at NorthShore University HealthSystem, Evanston, Ill., said during public comments.

Another leading concern was to ensure people did not undergo unnecessary chemotherapy. “We need to be on the side of the angels and minimize access to drugs that don’t necessarily need to be given,” said Dr. Josef Fischer, a panelist and professor in the surgery department at Harvard Medical School and Beth Israel Deaconess Medical Center.

The eight-member panel was asked to vote on a scale of 1 to 5 on how confident members were that the tests they were reviewing would actually benefit Medicare beneficiaries by bettering quality of life, helping them avoid inappropriate anti-cancer treatments or death. The tests that were up for consideration claim they help predict the chances of colon, rectum, breast and lung cancers.

Panel member votes were collected and averaged. Most of the tests received an average score under 3, though a test related to breast cancer rated higher at 3.8. Another test meant to find cancerous lung cancer genes scored the lowest at 1.375.

The panelists also were asked to discuss if they would feel more comfortable with a test being used by beneficiaries if it were a laboratory-developed test from a facility certified under the Clinical Laboratory Improvement Amendments or a test that received Food and Drug Administration approval or clearance. Members seemed more comfortable with an FDA-approved test.

It’s unclear what direction the CMS will take moving forward. MEDCAC is generally considered influential, but the agency recently decided to not concur with a committee vote to not recommend Medicare coverage of annual CT scans to detect lung cancer in heavy smokers.

During the meeting, CMS liaison Dr. James Rollins indicated that any future coverage given to these type of tests would need to prove clinical utility. Today, most entities developing these tests focus on proving analytical validity, how accurately a test detects a specific genetic variant, or clinical validity, how well the genetic variant is being analyzed.

See original article here.

Are Pesticides, Roundup, and Cancer in Children Connected?

Diet, Habits, & Other Behaviors, Environmental Exposures,
By Prianka Waghray and Avni Patel
2022

In murder mysteries, rat poison and pesticides intentionally added to food are sometimes used to kill.  Scientists have also warned they can cause birth defects.  However, more recent research shows that relatively low levels of pesticides and indoor bug sprays can cause cancer and other serious medical problems in children, and possibly adults.

A study published in 2020 found that children exposed to pesticides are more likely to develop cancer later in life. The study highlights an urgent need to prevent and child’s exposure to pesticides 1. Although it was already known that many chemicals used in pesticides, such as certain organophosphates, can cause cancer, the study aimed to find out how much exposure is likely to cause cancer in children.

The evidence about the risks of various chemicals has been growing. There is some evidence that high level of exposures to pesticides, especially among farm workers, may increase the chances of developing lung cancer, but more research is needed on which pesticides are most likely to cause harm 2. In 2019, a University of  Washington study showed that the use of a widely used weed killer called Roundup increases the chances of contracting non-Hodgkin lymphoma by 21% 3.  Children are especially vulnerable to even small amounts of insecticides and pesticides that are meant to kill rodents or insects, even in tick and flea sprays used on pets, because children are smaller than adults and their bodies and brains are still developing.  Roundup, which has been banned in 41 countries as of 2021 due to health concerns, as well as other weed killers are currently being investigated by scientists to learn more about the risks for adults and children. 4.

Even before the latest study, the American Academy of Pediatrics (AAP), which is the nonprofit organization for pediatricians, warned that children can be harmed by pesticides in their daily life.5. The AAP concludes that exposure to pesticides early in life can result in childhood cancers, behavioral problems, and lower scores on tests to measure thinking, reasoning, and remembering. They recommend that parents reduce their children’s exposure to pesticides as much as possible, by controlling bugs and other pests using non-chemical methods whenever possible, and by reducing the amount of pesticides in what children eat and drink.

Several studies have found, for instance, that children exposed to organophosphates, which are common in household insecticides, in their early years tend to have lower IQ and more likely to show the behaviors typical of autism and attention deficit and hyperactivity disorders.6

Several cancer-causing organophosphates have been banned from household pesticides. Unfortunately, they have been replaced with other organophosphates that have not yet been studied. Whether or not these chemicals cause cancer, they can be dangerous and children should not be exposed to them.8

Young children are more likely to be exposed to more pesticides and insecticides than adults because they are closer to the ground and often put whatever they find there, along with their own fingers, in their mouths. When bug spray or other pesticides are used in the home, chemical residues can linger in the air, on the floor or carpet where children crawl and play, and on toys.31 Children breathe in more pesticide than adults, too, because they are down low where the chemicals accumulate. Lawn and garden weed killers can be tracked in the house by pets or people, and left in carpets and rugs.

How can we reduce children’s exposure to pesticides?

The good news is that parents can reduce their children’s exposure to these chemicals. The easiest way is to stop using them in your home and garden. It is also safer to use roach motels, ant baits, and mouse traps instead of chemical sprays. You can weed the yard by hand instead of using weed killers (at least while your children are young).

What about the fruits and vegetables that you buy?  Be sure to wash, scrub, and peel fruits and vegetables if you don’t buy organic produce. Although washing and peeling fruits and vegetables doesn’t get rid of the pesticides that have been absorbed into the growing vegetable or fruit, it is still better than nothing. However, if you can afford to buy them, organic fruits and vegetables have the least amount of pesticide on and inside the fruit or vegetable.32

One way to reduce the use of bug sprays and other chemicals in the home is to not leave out food overnight that can attract bugs or rodents. Discourage rats by covering garbage cans.

If you must use pesticides, use the ones that are less toxic. If you aren’t sure how a product kills pests, look at the label. According to the EPA, pesticides with “warning” on the label are more dangerous to humans than the ones that say “caution.” Products with labels that say “danger” are the most harmful.33 34 Besides using the lowest risk products, be careful where you store pesticides, so that children can’t reach them and the chemicals won’t contaminate foods or medicines.

Is buying organic really better for you?

Researchers at Stanford University have concluded that organic fruits and vegetables are not more nutritious than other produce. However, they also found that children who eat organic produce have significantly lower levels of pesticides in their bodies than children who eat regular produce.35,36,37

Unfortunately, organic fruits and vegetables are not always available, and they are often more expensive. One way to eat organic less expensively is to limit your organic purchases to the fruits and vegetables on the Environmental Working Group’s (EWG) Dirty Dozen list.38 These are the 12 fruits and vegetables that tend to have the highest amount of pesticide residues. The list is constantly being updated based on recent test results so check it regularly (http://www.ewg.org/foodnews/). There is also a Clean 15 list, which lists 15 foods that have the least amount of pesticides and, therefore, are safe even when they are not organic. By following these lists, you can feed your children more safely without breaking the bank.

As of Feburary 2022, the Dirty Dozen consists of the following foods:

  1. Strawberries
  2. Dirty dozen; peachesSpinach
  3. Kale, collard, and mustard greens
  4. Nectarines
  5. Apples
  6. Grapes
  7. Cherries
  8. Peaches
  9. Pears
  10. Bell and hot peppers
  11. Celery
  12. Tomatoes

The Clean 15 list consists of the following foods, where it is not necessary to buy organic:

  1. Avocados
  2. Sweet Corn
  3. Pineapples
  4. Onionsclean 15; red onions
  5. Papaya
  6. Sweet Peas (frozen)
  7. Eggplant
  8. Asparagus
  9. Broccoli
  10. Cabbage
  11. Kiwi
  12. Cauliflower
  13. Mushrooms
  14. Honeydew Melon
  15. Cantaloupe

THE BOTTOM LINE

Even small amounts of pesticides are very harmful for children. They may cause behavior problems, harm children’s thinking and memory, and increase their risk of childhood cancers.  These chemicals can also harm adults, especially after years of exposure.  To help prevent these problems, limit your use of bug sprays, weed killers, and other pesticides and herbicides and buy organic fruits and vegetables that would otherwise have a lot of pesticide residue.

All articles on our website have been approved by Dr. Diana Zuckerman and other senior staff. 

 

Breast implants in France to carry cancer warning: researchers find a ‘clearly established link’

News Stories & Editorials, news-you-can-use
By Dana Dovey, Medical Daily
March 18, 2015

Following France’s National Cancer Institute finding a “clearly established link” between breast implants and a specific type of cancer, the country will now order all breast implants to come with a cancer warning. This announcement came after 18 cases of anaplastic large cell lymphoma were directly linked to women with silicone breast implants since 2011.

Anaplastic large cell lymphoma (ALCL) is a type of non-Hodgkin’s lymphoma that affects the blood. The link between breast implants and this form of cancer is extremely rare, so French officials have urged women who already have the implants not to remove them, the Daily Mail reported. Given the severity of the cancer in the few women who do develop it, French officials felt it necessary to inform women of all the possible risks associated with the surgery.

ALCL is extremely rare, affecting around one to six in every three million women who undergo breast augmentation, Medical News Today reported. However, a study conducted by researchers from Cambridge University in the UK found that nearly all cases of ALCL in breasts occurred in patients who had undergone breast augmentation, suggesting a link between the two. Although it’s not clear why silicone breast implants can sometimes cause cancer, the Cambridge investigation did shed some light on the mystery.

“It’s becoming clear that implant-related ALCL is a distinct clinical entity in itself,” Dr. Suzanne Turner, lead researcher of the Cambridge study, told Medical News Today. “There are still unanswered questions and only by getting to the bottom of this very rare disease will we be able to find alternative ways to treat it.”

Breast implants are a very popular surgery, with Dr. Diana Zukerman, president of the National Center for Health Research, explaining that in 2013 alone 300,000 American women opted for the operation. Of these women, around 80 percent undergo breast enhancement for cosmetic reasons while a further 20 percent have breast implants following breast cancer.

This is far from the first time that breast implants have been implicated in causing a health hazard. In 2011, French firm PIP caused global hysteria when plastic surgeons reported an abnormal amount of the implants rupture, the Daily Mail reported. It was later found that the firm had been manufacturing these breast implants using industrial grade silicone intended for use in mattresses.

The implants were subsequently found faulty and banned from use. Women who had already received the implants were advised to have them removed, although European health officials found no medical or toxicological evidence to back this advice.

See original article here.